A dry needle is placed in a strategic area of Joe Perales' neck during acupuncture treatments performed by Dr. Roger Pringle.

Photo: Karen Warren, Staff

A dry needle is placed in a strategic area of Joe Perales' neck...

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Dr. Roger Pringle, a chiropractor at the Kelsey-Seybold clinic, who has incorporated acupuncture into his practice, spray and stretches Joe Perales after dry needling his neck at the Main Campus, Wednesday,Oct. 9, 2013, in Houston. ( Karen Warren / Houston Chronicle )

Photo: Karen Warren, Staff

Dr. Roger Pringle, a chiropractor at the Kelsey-Seybold clinic, who...

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Dr. Roger Pringle, a chiropractor at the Kelsey-Seybold Clinic who has incorporated acupuncture into his practice, performs treatment on a patient.

Photo: Karen Warren, Staff

Dr. Roger Pringle, a chiropractor at the Kelsey-Seybold Clinic who...

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Dr. Roger Pringle, a chiropractor at the Kelsey-Seybold clinic, who has incorporated acupuncture into his practice, dry needles Joe Perales at the Main Campus, Wednesday,Oct. 9, 2013, in Houston. ( Karen Warren / Houston Chronicle )

Photo: Karen Warren, Staff

Dr. Roger Pringle, a chiropractor at the Kelsey-Seybold clinic, who...

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Dr. Roger Pringle, a chiropractor at the Kelsey-Seybold clinic, who has incorporated acupuncture into his practice, dry needles Joe Perales at the Main Campus, Wednesday,Oct. 9, 2013, in Houston. ( Karen Warren / Houston Chronicle )

Photo: Karen Warren, Staff

Dr. Roger Pringle, a chiropractor at the Kelsey-Seybold clinic, who...

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Dr. Roger Pringle, a chiropractor at the Kelsey-Seybold clinic, who has incorporated acupuncture into his practice, at the Spring Medical and Diagnostic Center, Wednesday,Oct. 9, 2013, in Houston. ( Karen Warren / Houston Chronicle )

Photo: Karen Warren, Staff

Dr. Roger Pringle, a chiropractor at the Kelsey-Seybold clinic, who...

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Dr. Roger Pringle, a chiropractor at the Kelsey-Seybold clinic, who has incorporated acupuncture into his practice, at the Spring Medical and Diagnostic Center, Wednesday,Oct. 9, 2013, in Houston. ( Karen Warren / Houston Chronicle )

Photo: Karen Warren, Staff

Dr. Roger Pringle, a chiropractor at the Kelsey-Seybold clinic, who...

Joe Perales sat on a patient bed in a clinic with his eyes closed and his neck stretched to the left. On his right shoulder, just below the nape of his neck, a tiny needle - so thin it would have barely been visible if not for its blue tip - protruded from his skin.

The 51-year-old marathon runner had come to the Kelsey-Seybold Clinic for an acupuncture treatment from Dr. Roger Pringle, a chiropractor and licensed acupuncturist. Perales had tension in his neck and thought acupuncture might ease his pain.

"Every time I've had acupuncture or even a deep-tissue massage, I felt better a week later more than I did the week before," said Perales, who has used acupuncture twice before for pain in his back and legs.

Practiced in China and other Asian countries for thousands of years, acupuncture involves penetrating the skin with thin needles to stimulate certain points on the body. Many people like Perales seek such treatments for a variety of ailments.

Over the years, acupuncture has seen a growing use by many American hospitals and health care providers for pain management. Although it is growing in popularity, there are still questions on whether it is effective.

"We use this usually in cases where we have difficulty with the traditional medical treatments," he said.

Sewielam noted many patients with chronic pain may not be candidates for therapies such as injections because of other health conditions or because they do not respond to traditional treatments. In those cases, he would suggest acupuncture.

Pringle, whose practice has included acupuncture for about six years, said most of his patients who respond well to the therapy are those with peripheral joint pain.

"So they'll have knee pain, foot pain, ankles, hands, wrists and elbows," he said, noting that he also recommends over-the-counter anti-inflammatories such as acetaminophen or ibuprofen.

Traditional Chinese acupuncture targets specific points to correct imbalances in the flow of qi, or the body's vital energy, through channels known as meridians. However, Pringle generally practices what is known as "dry needling," a variation of acupuncture that focuses on muscular trigger points that create pain, causing it to travel to a distant site on the body.

"I tend to try and think, 'What does the nervous system do and how does the nervous system behave?' and ways that maybe we can influence the nervous system," Pringle said.

Perales said his prior experiences involved traditional Chinese acupuncture and 10 to 20 needles were used in each procedure. That day, Pringle only used a single needle, placing it in a trigger point he believed was the source of Perales' pain.

Other health care providers in Houston provide acupuncture treatments for their patients.

At the Institute for Rehabilitation and Research Memorial Hermann, an acupuncturist is on staff to help patients who have suffered injuries in accidents such as car crashes. The Memorial Hermann Hospital system also offers acupuncture as a therapy through its new pain recovery program. The 6-month-old inpatient program, run through the hospital's Prevention and Recovery Center, provides treatment for people struggling with addiction to pain medications. Its goal is to help patients learn to manage their pain without the use of medication, said the program's manager Christie Taylor.

Acupuncture is given to patients throughout their stay at the program. Taylor said it is used alongside other detox treatments.

"Even the ones that are in detox, the acupuncture really helps reduce a lot of their discomfort," she said.

While there are some who sing the praises of acupuncture, the technique's efficacy is still questioned by many in the medical community. They question if acupuncture's victories are simply the result of a placebo effect. Existing studies have been criticized for small data pools or poor methodology.

Dr. Donald Marcus, a rheumatologist and Professor of Medicine and Immunology Emeritus at Baylor College of Medicine, has written several academic papers on the practices and functionality of complementary and alternative medicine, such as acupuncture and herbal supplements. Marcus believes that the positive results of acupuncture are most likely a placebo effect. He said the inert procedures used in clinical studies often show just as much efficacy as the actual treatment.

"I think it's been known for a very long time that placebo effects are very powerful in relieving in pain," he said. "So it's not surprising that if people get acupuncture, they have some temporary relief of their pain, but it's a placebo effect."

Marcus said other factors can play a role in the success of acupuncture - generally is not covered by insurance. He said another factor is that patients frequently seek treatment when pain is most severe. But pain fluctuates, he stressed, and what seemed bad initially, may only be returning to a baseline a few days later - rather than acupuncture playing a role in the relief.

"The best way to deal with the pain, depending on what it is, is to understand the cause of the pain, and what can be done," he said.

M.D. Anderson offers acupuncture to patients suffering anything from nausea to pain either caused by the cancer or its treatments.

Dr. Kay Garcia, associate professor of general oncology and licensed acupuncturist in the integrative medicine program at the University of Texas M.D. Anderson Cancer Center, said there is evidence that acupuncture may help patients whose pain is not well-managed such as those suffering from joint pain such as osteoarthritis of the knee.

Last year, a nearly five-year study on acupuncture and pain found that the procedure worked against chronic pain. Funded by the National Institutes of Health, the study was a detailed analysis of earlier research data for nearly 18,000 patients. The meta-anaylsis, the largest conducted of its kind, found that differences between true and inert acupuncture indicate that acupuncture really worked.

"There is evidence that it goes above and beyond a placebo effect, (that there is) a biological effect that goes beyond a placebo effect for pain," said Garcia, adding that it's hard to gauge the effects of acupuncture on cancer patients because their pain is so complex..

In a systematic review of acupuncture in cancer care, published in the Journal of Clinical Oncology in January, results showed that acupuncture helps alleviate symptoms such as nausea and vomiting in cancer patients undergoing chemotherapy. However, it also concluded the therapy's effects are not definitive and more studies are needed, said Garcia, an author of the report.

In her own experience with cancer patients, Garcia said the patients who show the most benefit from acupuncture are those who are using the therapy with traditional medical treatments.

"I don't see it as a magic bullet; it doesn't work for everyone," she said. "But it can be an important adjunct that can significantly reduce a patient's suffering."